Modelling the combined impact of interventions in averting deaths during a synthetic-opioid overdose epidemic
Modelling the combined impact of interventions in averting deaths during a synthetic-opioid overdose epidemic
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DOI：
10.1111/add.14664
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发表时间：
2019-06-28
期刊：
影响因子：
6
通讯作者：
Gilbert, Mark
中科院分区：
文献类型：
--
作者：
Irvine, Michael A.;Kuo, Margot;Gilbert, Mark
背景和目标加拿大不列颠哥伦比亚省（BC）在过去4年中，非法药物过量和死亡人数迅速增加，并于2016年4月宣布进入省级紧急状态。造成这些死亡的主要原因是将合成类阿片引入非法类阿片供应。这项研究旨在衡量2016年4月至2017年12月在不列颠哥伦比亚省实施的大规模阿片类药物过量干预措施对避免死亡人数的综合影响。设计我们扩展了我们以前研究的数学建模方法，构建贝叶斯分层潜在马尔可夫过程模型，以估计每月过量和过量死亡风险，沿着干预措施的影响。2012年1月至2017年12月不列颠哥伦比亚省的过量事件和过量相关死亡。干预措施考虑的干预措施是带回家的纳洛酮试剂盒，过量预防/监督消费网站和阿片类激动剂治疗测量使用拟合模型进行反事实模拟，以估计每种干预措施和组合避免的死亡事件数量。在2016年4月至2017年12月期间，BC观察到2177例过量死亡（77%芬太尼检测）。在同一时期，估计有3030（2900-3240）例死亡事件是通过所有干预措施共同避免的。单独来看，1580例（1480-1740）通过带回家的纳洛酮避免，230例（160-350）通过过量预防服务避免，590例（510-720）通过阿片类激动剂治疗避免。结论自宣布公共卫生紧急事件以来（2016年4月至2017年12月），联合干预方法在不列颠哥伦比亚省阿片类药物过量危机期间有效避免了过量死亡。然而，过量死亡的绝对数字没有变化。
Background and aims The province of British Columbia (BC) Canada has experienced a rapid increase in illicit drug overdoses and deaths during the last 4 years, with a provincial emergency declared in April 2016. These deaths have been driven primarily by the introduction of synthetic opioids into the illicit opioid supply. This study aimed to measure the combined impact of large-scale opioid overdose interventions implemented in BC between April 2016 and December 2017 on the number of deaths averted. Design We expanded on the mathematical modelling methodology of our previous study to construct a Bayesian hierarchical latent Markov process model to estimate monthly overdose and overdose-death risk, along with the impact of interventions. Setting and Cases Overdose events and overdose-related deaths in BC from January 2012 to December 2017. Interventions The interventions considered were take-home naloxone kits, overdose prevention/supervised consumption sites and opioid agonist therapy Measurements Counterfactual simulations were performed with the fitted model to estimate the number of death events averted for each intervention and in combination. Findings Between April 2016 and December 2017, BC observed 2177 overdose deaths (77% fentanyl-detected). During the same period, an estimated 3030 (2900-3240) death events were averted by all interventions combined. In isolation, 1580 (1480-1740) were averted by take-home naloxone, 230 (160-350) by overdose prevention services and 590 (510-720) were averted by opioid agonist therapy. Conclusions A combined intervention approach has been effective in averting overdose deaths during British Columbia's opioid overdose crisis in the period since declaration of a public health emergency (April 2016-December 2017). However, the absolute numbers of overdose deaths have not changed.